Scarring and Breast Cancer - Risks, Effects, and Healing

What Procedures for Breast Cancer Treatment Cause Scarring?

woman showing a scar on her chest from breast cancer treatment
What should you know about scarring and breast cancer treatment?. Credit: The Washington Post / Contributor / Getty Images

Scarring Due to Breast Cancer Treatment

If you've been diagnosed with early stage breast cancer, usually considered DCIS to stage 3A breast cancer, you will likely have surgery. Unfortunately, any time an incision is made through the layers of the skin, a scar is inevitable. Plastic surgery doesn't mean you won't have scar; only that plastic surgeons use the science behind healing to minimize the appearance of the scar as much as possible.

That said, disfigurement due to breast cancer treatment is not inevitable.

What Breast Cancer Treatments Cause Scarring

You may be thinking lumpectomy or mastectomy when you think of scarring, yet there are other procedures related to breast cancer which can cause scarring as well. Being prepared for some of these "additional scars" ahead of time may keep these from being an unwanted surprise later on.

If you have a chemotherapy port placed for chemotherapy, the incision (usually just beneath your collar born) will leave a scar.

Radiation therapy can also result in scarring, though the scarring is different than scars from surgery. Breast fibrosis from radiation therapy can lead to stiffness or a thickening in the region where you received radiation. Sometimes the skin changes related to radiation therapy—such as redness or sores you may have developed such as blisters—can be permanent. It's not uncommon to have what appears to be a permanent (but often irregular) "suntan" on your chest related to radiation.

Yet another treatment that can result in scarring is lymph node dissection and removal. While this scarring isn't usually visible, other than in a swimsuit, it can cause tightness and restricted movement in your arm. Surgeons differ in their approaches to the lymph node removal.

Finally, the drains that are placed after breast cancer surgery leave small round scars when removed.

The amount of scarring will depend on how many drains you have and how long these drains need to be left in place.

Factors That Affect Scarring in Breast Cancer Treatment

The amount and extent of scarring that results from breast cancer treatment depends on several factors, including the type of surgery performed and each patient's individual propensity to form scar tissue. Smoking can result in delayed healing and, in turn, increased scarring. Some people have a tendency to develop keloid scars, thick raised scars where an incision was made.

Scarring with Lumpectomies vs Mastectomy

in general, lumpectomy involves a smaller incision than a mastectomy, although, depending on the location of the tumor, may result in indentations or unevenness of the breast. Radiation given after a lumpectomy may also cause thickening of breast tissue.

Breast Reconstruction and Scarring

Breast reconstruction is an option both to rebuild a breast in those who have had a mastectomy or to even out a breast on which a lumpectomy has been performed.

Since breast reconstruction involves surgery, these procedures all carry the risk of scarring. Often times a reconstruction is performed using the same incision site as a lumpectomy or mastectomy to minimize scarring.

If you will be having a flap procedure, either a TRAM flap using skin from your abdomen or a latissimus dorsi flap using skin from your back, you will have additional scarring at the site from which this tissue is harvested. If you choose to have nipple reconstruction, this may be considered a type of scarring as well.

Breast Reconstruction, Radiation Therapy, and Scarring

A concern that is not raised enough is when breast cancer reconstruction (primary reconstruction) is done, and a woman later chooses to have radiation therapy, often due to the unexpected findings of positive lymph nodes during surgery.

Tissue that has been treated with radiation is both more difficult for the surgeon to work with and can result in delayed healing. If you choose to have primary reconstruction after a mastectomy, talk with your doctor about the chance that you may require radiation therapy, and what that might mean for you.

Breast Scars, Body Image, and Intimacy

Scarring related to breast cancer surgery can be very emotional for women. Scarring can affect your body image, and in doing so, can create problems with intimacy. Some women are bothered very little, whereas others find these changes extremely distressing.

If you are concerned about scarring beforehand or having difficulty coping later on, don't hesitate to talk to a counselor. Becoming involved in a support group is also very helpful for many people who find coping with their changed body image a challenge.

Learn more about how breast cancer may affect your body image.

Healing and Dealing With Scars

One of the best ways to limit scarring is by preventing infection immediately after surgery. Many patients are sent home from the hospital with drains attached to their incisions that remove excess blood and lymph fluid from the site. After these are taken out a few days later, patients need to keep the wound as clean as possible as it continues to heal and carefully follow doctor's orders regarding bandage changes.

Smoking can result in delayed healing, and it is important to quit smoking if you smoke in order to have the best cosmetic result from your surgery.

Other scar-reducing techniques include lightly stretching and massaging the scar area daily during the first year when most healing occurs (talk to your surgeon first.) Known by therapists as transverse friction massage, it involves gently manipulating the skin perpendicularly above and below the incision, from the collar bone to the bottom of the ribcage, and from the breastbone to under the armpits.

Since the implications of scarring aren't only cosmetic—pain and tightness can also result—professionals are sometimes needed to help ease the patient's scar tissue into a healthier healing pattern. Using vigorous, deep and soft-tissue massage, physical therapists may help relieve the pain and feelings of constriction.  New techniques are also being developed in using lasers, Botox,  and cytokines.

Alternative therapies can include yoga, which involves deep breathing and whole-body stretches, and also acupuncture, which uses thin needles inserted just below the skin in certain areas to relieve pain. One way to deal with a scar is to conceal it with a tattoo. That's an option gaining in popularity.

Coping with Your Breast Cancer Scars

Most of us have scars of some sort by the time we hit the age that most breast cancers arise. These scars are not always visible, and sometimes our emotional scars are more difficult to deal with than our physical scars. If you are coping with scars related to breast cancer, perhaps one of the quotes talking about scars may help just a bit. "A scar simply means that you were stronger than whatever tried to hurt you." (author unknown). 

Sources:

Hammer, C., Maduro, J., Bantema-Joppe, E. et al. Radiation-Induced Fibrosis in the Boost Area after Three-Dimensional Comformal Radiotherapy with a Simultaneous Integrated Boost Technique for Early-Stage Breast Cancer: A Multivariable Prediction Model. Radiotherapy and Oncology. 2016 Oct 25. (Epub ahead of print).

Liu, A., Moy, R., and D. Ozog. Current Methods Employed in the Prevention and Minimization of Surgical Scars. Dermatologic Surgery. 2011. 37(12):1740-6.

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